Provider Demographics
NPI:1811151889
Name:HALLOCK, SANDY ZAK (DMD)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:ZAK
Last Name:HALLOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4845
Mailing Address - Country:US
Mailing Address - Phone:937-867-7664
Mailing Address - Fax:937-296-9678
Practice Address - Street 1:3716 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-4845
Practice Address - Country:US
Practice Address - Phone:937-867-7664
Practice Address - Fax:937-296-9678
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0227871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice